New Irish Research Prompts UCD Professor to Call for Updated National Folic Acid Awareness Campaign
-Only one in four pregnant women have taken folic acid as recommended prior to conception
-Incidence of neural tube defects increasing in Ireland despite being largely preventable, reversing the previous trend
-Public health education campaign should focus on vulnerable women of childbearing age
The findings of new research studies relating to levels of folic acid supplementation by women in Ireland have prompted Professor Michael Turner, UCD Professor of Obstetrics and Gynaecology, Coombe Women & Infants University Hospital, to call for an updated public health campaign be mounted as a matter of urgency. Taking folic acid is proven to supplement the naturally-occurring B vitamin which aids the healthy development of a baby’s spine in the first trimester, thus helping to prevent neural tube defects such as spina bifida and anencephaly.
One study1 (McKeating A et al, 2015), which involved over 42,000 women attending the Coombe Women & Infants University Hospital between 2009 and 2013, found that the rate of folic acid supplementation was worryingly low among women, with less than half taking a folic acid supplement prior to conception. Furthermore, another study2 from the UCD Centre of Human Reproduction in the Coombe found that only a quarter of the women who participated in the study were taking a folic acid supplement for at least 12 weeks before conception (Cawley S et al, 2015). This finding is all the more worrying in light of a recent review3 of neural tube defects in Ireland showing that the incidence of such conditions is on the increase among babies born here, reversing a previous downward trend (McDonnell R et al, 2014).
Commenting on these recent findings, Professor Turner, Director of the UCD Centre for Human Reproduction, said
The importance of pre-pregnancy folic acid supplementation is a crucial public health message and an updated public health campaign is now required as a matter of urgency in Ireland. Our extensive research has shown very low levels of folic acid supplementation prior to conception which is particularly worrying given that the rate of neural tube defects, one of the few preventable major congenital malformations, is on the rise in Ireland.
A folic acid supplement should be taken for at least 12 weeks before conception to allow time for the blood concentration of folate to reach the protective range. However, Professor Turner maintains that all women who could potentially become pregnant, whether trying to conceive or not, should consider taking a folic acid supplement.
Our research deduced that one in three pregnancies is unplanned. Therefore, our recommendation is that all women of childbearing age should consider taking a folic acid supplement before they are actively trying to become pregnant so that they reduce their baby's risk of neural tube defects, should they go on to conceive.
This assertion is corroborated by Dr Aoife McKeating, UCD Research Fellow, who emphasised that low or insufficient levels of pre-conception folic acid supplementation are often linked with occurrences of unplanned pregnancy
Our research has shown that the risk of unplanned pregnancy is highest among women under the age of 20, who are unemployed and/ or have a history of depression or domestic violence, in other words, very vulnerable groups of women.
With regard to maternal obesity Dr McKeating stressed
We have found that compared with women with a normal BMI (18.5 – 24.9kg/m2), obese women (BMI >29. 9kg/m2) were more likely to have an unplanned pregnancy associated with higher non-hormonal and hormonal contraceptive failure rates and a higher rate of contraceptive non-use.
While the standard over-the-counter dose of folic acid is 0.4mg, the recommended dose for high risk groups including obese women, women with epilepsy and those who have had a previous baby affected by a neural tube defect, is 5mg. Commenting on this, Dr McKeating said
Worryingly, of the obese women who did take a folic acid supplement, less than 2% took the recommended high dose (5mg) even though obese women are at an increased risk of having a baby with neural tube defects including spina bifida and anencephaly.
In light of this recent scientific evidence, Professor Turner is calling for national guidelines on pre-pregnancy folic acid supplementation to be updated and brought to the attention of women nationwide via a public health information campaign.
While there is most certainly a pronounced need to reach vulnerable women who may become pregnant in the future with this message, our findings are relevant to all women of childbearing age and a public health campaign should now be orchestrated as a matter of urgency.
Notes to the Editor:
1 McKeating, A et al. Maternal folic acid supplementation trends: a prospective observational study 2009-13
2 Cawley, S et al. An analysis of folic acid supplementation in women presenting for antenatal care
3 McDonnell, R et al. Neural tube defects in the Republic of Ireland in 2009-11
Prof. Michael Turner, UCD Professor of Obstetrics and Gynaecology, Coombe Women & Infants University Hospital St Vincent’s University Hospital and Director of UCD Centre for Human Reproduction.
Dr. Aoife McKeating, Research Fellow in Obstetrics and Gynaecology, UCD Centre for Human Reproduction in the Coombe Women & Infants University Hospital. Research interests include maternal health behaviours and the social determinants of unplanned pregnancy and its associated maternal and neonatal outcomes. This research is funded by a grant from the HSE Crisis Pregnancy Programme.
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